Kidney Week

Abstract: FR-PO208

The Intersection between Chimeric Antigen Receptor T Cell (CAR-T) Therapy and the Kidneys: A Multicenter Study of Outcomes

Session Information

• Onconephrology: Immunotherapy Nephrotoxicity and Assessment of GFR
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Matarneh, Ahmad, Penn State College of Medicine, Hershey, Pennsylvania, United States

Ahmad Matarneh, MD

• Sardar, Sundus, Penn State College of Medicine, Hershey, Pennsylvania, United States

Sundus Sardar, MD

• Portela, Rafael, Penn State College of Medicine, Hershey, Pennsylvania, United States

Rafael Portela, MD

• Abdulbasit, Muhammad, Penn State College of Medicine, Hershey, Pennsylvania, United States

Muhammad Abdulbasit, MD

• Verma, Navin, Penn State College of Medicine, Hershey, Pennsylvania, United States

Navin Verma, MD

• Trivedi, Naman, Penn State College of Medicine, Hershey, Pennsylvania, United States

Naman Trivedi, MBBS, MPH

• Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States

Nasrollah Ghahramani, MD, FASN

Background

Chimeric Antigen Receptor T-cell (CAR-T) therapy has revolutionized the treatment of refractory hematologic malignancies. Despite its remarkable efficacy, CAR-T therapy is associated with serious adverse effects, including electrolyte abnormalities and acute kidney injury (AKI).

Methods

This study aims to determine the incidence of electrolyte abnormalities and AKI in patients receiving CAR-T therapy. Additionally, we assessed survival outcomes following these events and compared risk differences in patients with and without AKI.

We conducted a retrospective multi-center cohort study using the TriNetX database. We identified 3,537 patients who received CAR-T therapy and subsequently developed electrolyte abnormalities or AKI. Survival following these events was also evaluated

Results

The incidences of abnormalities and respective survival properties were as follows:
- Hyponatremia:16.5%, survival probability: 78.9%.
- Hypernatremia: 3.8%, survival probability: 94.9%.
- Hypocalcemia: 7%, survival probability: 90.4%
- Hypercalcemia: 6.6%, survival probability: 91.2%.
- Hypophosphatemia: 14.7%, survival probability: 80.7%.
- Hyperphosphatemia: 1.5%, survival probability: 80.5%.
- AKI: 22.4%, survival probability: 70.4%.

Compared with the non-AKI cohort, the AKI group had a higher incidence of:
- Hyponatremia (24% vs. 14%), associated with lower survival (67.7% vs. 83.1%);
- Hypernatremia (8.7% vs. 1.3%), associated with lower survival (88.2% vs. 98.2%);
- Hypocalcemia (11.7% vs. 5.8%), associated with lower survival (84.2% vs. 93.2%);
- Hypercalcemia (11.6% vs. 3.6%), associated with lower survival (84.5% vs. 95.2%).
- Hypophosphatemia (25% vs. 12.2%), associated with lower survival (66% vs. 85.1%);
- Hyperphosphatemia (25.5% vs. 12.2%), with similar survival

Mortality was higher in patients with AKI following CAR-T therapy, with a risk of 39.5% compared to 18.2% in patients without AKI (RR 0.461, 95% CI 0.415-0.512).

Conclusion

CAR-T therapy is associated with multiple electrolyte derangements and a significant incidence of AKI. These imbalances correlate with increased mortality risk. Patients who develop AKI are at higher risk of electrolyte abnormalities and have lower survival probabilities. Overall, careful monitoring and management of electrolyte disturbances in patients undergoing CAR-T therapy are crucial.